Ovarian germ cell tumor is a disease in which malignant
(cancer) cells form in the germ (egg) cells of the ovary.

Germ cell tumors begin
in the reproductive cells (egg or
sperm) of the body. Ovarian germ
cell tumors usually occur in teenage girls or young women and most often affect
just one ovary.

The ovaries are a pair of organs in the female
reproductive system. They are
in the pelvis, one on each
side of the uterus (the hollow,
pear-shaped organ where a fetus
grows). Each ovary is about the size and shape of an almond. The ovaries
make eggs and female hormones.

Anatomy of the female reproductive system. The organs in the female reproductive system include the uterus, ovaries, fallopian tubes, cervix, and vagina. The uterus has a muscular outer layer called the myometrium and an inner lining called the endometrium.

Ovarian germ cell tumor is a general name that is used to describe
several different types of cancer. The
most common ovarian germ cell tumor is called dysgerminoma. See the following PDQ
summaries for information
about other types of ovarian tumors:

Ovarian Epithelial Cancer
Treatment

Ovarian
Low Malignant Potential Tumors Treatment

Signs of ovarian germ cell tumor are swelling of the
abdomen or vaginal bleeding after menopause.

Ovarian germ cell tumors can be hard to diagnose (find) early.
Often there are no symptoms in the
early stages, but
tumors may be found during regular
gynecologic exams (checkups). Check with your doctor if you have either of the following:

Swollen
abdomen without weight gain in other
parts of the body.

Bleeding from the vagina after menopause (when you are no longer having
menstrual periods).

Tests that examine the ovaries, pelvic area, blood, and ovarian
tissue are used to detect (find) and diagnose ovarian germ cell tumor.

The following tests and procedures may be used:

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and the other hand is placed over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. A speculum is also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test or Pap smear of the cervix is usually done. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.

Pelvic exam. A doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and presses on the lower abdomen with the other hand. This is done to feel the size, shape, and position of the uterus and ovaries. The vagina, cervix, fallopian tubes, and rectum are also checked.

Laparotomy: A surgical procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease. The size of the incision depends on the reason the laparotomy is being done. Sometimes organs are removed or tissue samples are taken and checked under a microscope for signs of disease.

CT scan (CAT scan):
A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

Serum tumor marker test: A procedure in which a sample of blood is checked to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers. An increased level of alpha fetoprotein (AFP) or human chorionic gonadotropin (HCG) in the blood may be a sign of ovarian germ cell tumor.

After ovarian germ cell tumor has been diagnosed, tests
are done to find out if cancer cells have spread within the ovary or to other
parts of the body.

The process used to find out whether cancer has spread within the
ovary or to other parts of the body
is called staging. The information gathered from the
staging process determines the stage of the disease. Unless a doctor is sure the cancer has spread from the ovaries to other parts
of the body, an
operation called a laparotomy is done to see if the cancer has spread. The
doctor must cut into the abdomen and
carefully look at all the organs to see if they have cancer in them. The doctor will
cut out small pieces of tissue so they can be checked under a microscope for signs of cancer. The doctor may also wash the
abdominal cavity with fluid, which is also checked under a microscope to see if it has cancer cells in it.
Usually the doctor will remove the cancer and other organs that have cancer in them
during the laparotomy. It is important
to know the stage in
order to plan treatment.

Many of the tests used to diagnose ovarian germ cell tumor are also used for staging.
The following tests and procedures may also be used for staging:

PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Transvaginal ultrasound exam: A procedure used to examine the vagina, uterus, fallopian tubes, and bladder. An ultrasound transducer (probe) is inserted into the vagina and used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The doctor can identify tumors by looking at the sonogram.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

Tissue. The cancer spreads from where it began by growing into nearby areas.

Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.

Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.

Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of tumor as the primary tumor. For example, if an ovarian germ cell tumor spreads to the liver, the tumor cells in the liver are actually cancerous ovarian germ cells. The disease is metastatic ovarian germ cell tumor, not liver cancer.

The following stages are used for ovarian germ cell
tumors:

Stage I

Ovarian cancer stage IA, IB, and IC. In stage IA, cancer is found inside a single ovary. In stage IB, cancer is found inside both ovaries. In stage IC, cancer is found in one or both ovaries and one of the following is true: (a) cancer is found on the outside surface of one or both ovaries, (b) the capsule (outer covering) of the ovary has broken open, or (c) cancer cells are found floating in the peritoneal fluid surrounding abdominal organs or in washings of the peritoneum.

In stage I, cancer is found in one or both ovaries. Stage I is divided into stage IA, stage
IB, and stage IC.

Stage IA: Cancer is found inside a single ovary.

Stage IB: Cancer is found inside both ovaries.

Stage IC: Cancer is found inside one or both ovaries and one of the following is true:

cancer is also found on the outside surface of one
or both ovaries; or

the capsule (outer covering) of the ovary has
ruptured (broken open); or

cancer cells are found in the fluid of the peritoneal cavity (the body cavity that contains
most of the organs in the abdomen) or in washings of the peritoneum (tissue lining the peritoneal
cavity).

Stage II

Ovarian cancer stage IIA, IIB, and IIC. In stage IIA, cancer is found inside one or both ovaries and has spread to the uterus and/or the fallopian tubes. In stage IIB, cancer is found inside one or both ovaries and has spread to other tissues within the pelvis. In stage IIC, cancer is found inside one or both ovaries and has spread to the uterus and/or fallopian tubes and/or other tissue within the pelvis, and one of the following is true: (a) cancer is found on the outside surface of one or both ovaries, (b) the capsule (outer covering) of the ovary has broken open, or (c) cancer cells are found floating in the peritoneal fluid surrounding abdominal organs or in washings of the peritoneum.

In stage II, cancer is found in one or both ovaries and has spread into other areas of the pelvis. Stage II is divided into
stage IIA, stage IIB, and stage IIC.

Stage IIA: Cancer has spread to the
uterus and/or
fallopian tubes (the long slender
tubes through which eggs pass from the ovaries to the uterus).

Stage IIB: Cancer has spread to other tissue within the
pelvis.

Stage IIC: Cancer is found inside one or both ovaries and has spread to the uterus and/or fallopian tubes, or to other tissue within the pelvis. Also, one of the following is true:

cancer is found on the outside surface of one or both
ovaries; or

the capsule (outer covering) of the ovary
has ruptured (broken open); or

cancer cells
are found in the fluid of the peritoneal cavity (the body cavity that contains
most of the organs in the abdomen) or in washings of the peritoneum (tissue lining the peritoneal
cavity).

Pea, peanut, walnut, and lime show tumor sizes.

Stage III

In stage III, cancer
is found in one or both ovaries and has spread outside the pelvis to other parts of the abdomen and/or nearby lymph nodes.
Stage III is divided into stage IIIA, stage
IIIB, and stage IIIC.

Stage IIIA: The tumor is found in the pelvis only, but
cancer cells that can be seen only with a microscope have spread to the surface of the peritoneum (tissue that lines
the abdominal wall and covers most of the organs in the abdomen), the small intestines, or the tissue that connects the small intestines to the wall of the abdomen.

Stage IIIA ovarian cancer. In stage IIIA, cancer is found in one or both ovaries and has spread to other tissue within the pelvis. Cancer cells that can only be seen with a microscope have spread to the surface of the peritoneum. Cancer that has spread to the surface of the liver is also considered to be stage III.

Stage IIIB: Cancer has spread to the peritoneum and the cancer in the peritoneum is 2 centimeters or smaller.

Stage IIIB ovarian cancer. In stage IIIB, cancer is found in one or both ovaries and has spread to other tissue within the abdomen and to the peritoneum, where it is 2 centimeters or smaller in diameter. Cancer that has spread to the surface of the liver is also considered to be stage III.

Stage IIIC: Cancer has spread to the peritoneum and the cancer in the peritoneum is
larger than 2 centimeters and/or cancer has spread to
lymph nodes in the abdomen.

Stage IIIC ovarian cancer. In stage IIIC, cancer is found in one or both ovaries and has spread to (a) the peritoneum, where it is larger than 2 centimeters in diameter, and/or (b) lymph nodes in the abdomen. Cancer that has spread to the surface of the liver is also considered to be stage III.

Cancer that has spread to the surface of the liver is also considered stage III ovarian cancer.

Stage IV

Stage IV ovarian cancer. Cancer is found in one or both ovaries and may spread to other parts of the body, such as the lymph nodes, lung, liver, and bone. Cancer cells may also be found in an area between the lungs and the chest wall that has filled with fluid.

In stage IV, cancer has spread beyond the abdomen to other parts of the body, such as the lungs or tissue inside the liver.

Cancer cells in the fluid around the lungs is also considered stage IV ovarian cancer.

There are different types of treatment for patients with ovarian germ cell
tumors.

Different types of treatment are available for patients with ovarian germ cell tumor. Some treatments are standard (the currently used treatment), and some
are being tested in clinical trials.
A treatment clinical trial is a research study meant to help
improve current treatments or obtain information on new treatments for patients
with cancer. When clinical trials show that a new treatment is better than the
standard treatment, the new
treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Four types of standard treatment are used:

Surgery

Surgery is the most common
treatment of ovarian germ cell tumor. A doctor may take out the
cancer using one of the following
types of surgery.

Unilateral salpingo-oophorectomy: A surgical procedure to remove one ovary and one fallopian tube.

Total hysterectomy: A surgical procedure to remove the uterus, including the cervix. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision (cut) in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.

Hysterectomy. The uterus is surgically removed with or without other organs or tissues. In a total hysterectomy, the uterus and cervix are removed. In a total hysterectomy with salpingo-oophorectomy, (a) the uterus plus one (unilateral) ovary and fallopian tube are removed; or (b) the uterus plus both (bilateral) ovaries and fallopian tubes are removed. In a radical hysterectomy, the uterus, cervix, both ovaries, both fallopian tubes, and nearby tissue are removed. These procedures are done using a low transverse incision or a vertical incision.

Bilateral salpingo-oophorectomy: A surgical procedure to remove both ovaries and both fallopian tubes.

Tumor debulking:
A surgical procedure in which as much of the tumor as possible is removed. Some tumors may not be able to be completely removed.

Even if the doctor removes all the cancer that can be seen at the
time of the operation, some patients may be offered chemotherapy or radiation therapy
after surgery to kill any cancer cells that are left. Treatment given after the
surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

After chemotherapy for an ovarian germ cell tumor, a second-look laparotomy may be done. This is similar to the laparotomy that is done to find out the stage of the cancer. Second-look laparotomy is a surgical procedure to find out if tumor cells are left after primary treatment. During this procedure, the doctor will take samples of lymph nodes and other tissues in the abdomen to see if any cancer is left. This procedure is not done for dysgerminomas.

Observation

Observation is closely watching a patient’s condition without giving any treatment unless signs or symptoms appear or change.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web
site.

High-dose chemotherapy with bone marrow
transplant

High-dose chemotherapy with bone marrow
transplant is a method of giving very high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.

New treatment options

Combination
chemotherapy (the use of more than one anticancer drug) is being tested in clinical trials.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I ovarian germ cell tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.

Treatment depends on whether the tumor is a dysgerminoma or another
type of ovarian germ cell tumor.

Treatment of dysgerminoma may be either:

total abdominal hysterectomy and
bilateral salpingo-oophorectomy followed by radiation therapy or combination chemotherapy; or

unilateral salpingo-oophorectomy followed by chemotherapy.

Treatment of other ovarian germ cell tumors may include the following:

Unilateral salpingo-oophorectomy followed by combination
chemotherapy.

Second-look laparotomy (surgery done after primary treatment to see if tumor cells remain).

A clinical trial
of a new treatment.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage II ovarian germ cell tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.

Treatment depends on whether the tumor is a dysgerminoma or another
type of ovarian germ cell tumor.

Treatment of dysgerminoma may include the following:

Total abdominal hysterectomy and bilateral salpingo-oophorectomy, with
removal of as much of the cancer in
the pelvis and
abdomen as possible.

Unilateral salpingo-oophorectomy followed by chemotherapy.

Treatment of other ovarian germ cell tumors may include the following:

Total abdominal hysterectomy and bilateral salpingo-oophorectomy, with
removal of as much of the cancer in the pelvis and abdomen as possible.
Chemotherapy will be given before and/or after surgery.

Unilateral salpingo-oophorectomy followed by chemotherapy.

Second-look laparotomy (surgery done after primary treatment to see if tumor cells remain).

A clinical trial of a new treatment.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III ovarian germ cell tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.

Treatment depends on whether the tumor is a dysgerminoma or another
type of ovarian germ cell tumor.

Treatment of dysgerminoma may include the following:

Total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by
chemotherapy, with removal of as much of the cancer in the pelvis and abdomen
as possible.

Unilateral salpingo-oophorectomy followed by chemotherapy.

Treatment of other ovarian germ cell tumors may include the following:

Total abdominal hysterectomy and bilateral salpingo-oophorectomy, with
removal of as much of the cancer in the pelvis and abdomen as possible.
Chemotherapy will be given before and/or after surgery.

Unilateral salpingo-oophorectomy followed by chemotherapy.

Second-look laparotomy (surgery done after primary treatment to see if tumor cells remain).

A clinical trial of a new treatment.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IV ovarian germ cell tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.

Treatment depends on whether the tumor is a dysgerminoma or another type of
ovarian germ cell tumor.

Treatment of dysgerminoma may be:

Chemotherapy with or
without radiation
therapy.

Treatment of other ovarian germ cell tumors may include the following:

Chemotherapy.

Surgery with or
without chemotherapy.

A clinical trial of high-dose chemotherapy followed by
bone marrow
transplant.

A clinical trial of a new treatment.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent ovarian germ cell tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.

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